C. A. Mouch1, J. Goldstick3, M. A. Walton3,4, M. A. Zimmerman5, R. M. Cunningham2,3, P. M. Carter2,3 1Michigan Medicine,Department Of Surgery,Ann Arbor, MI, USA 2Michigan Medicine,Department Of Emergency Medicine,Ann Arbor, MI, USA 3University of Michigan,Injury Prevention Center,Ann Arbor, MI, USA 4Michigan Medicine,Department Of Psychiatry,Ann Arbor, MI, USA 5University of Michigan,School Of Public Health,Ann Arbor, MI, USA
Introduction: Firearms are the leading cause of trauma-related mortality among urban youth and emerging adults (EAs). However, little is known about patterns of risky firearm behaviors (i.e., firearm carriage in high-risk situations; firearm discharge in high-risk situations; firearm threats or use against another person) that may increase the likelihood of subsequent injury or death. This analysis examines rates and correlates of risky firearm behaviors (RFBs) to inform future prevention efforts, including current hospital-based violence prevention programs.
Methods: Youth/EAs (age 16-29) seeking ED treatment in an urban Level-1 trauma center completed a computerized survey. Validated measures assessed past 3-month risky firearm behaviors (RFBs), including firearm carriage in high-risk situations (i.e. carriage under the influence of alcohol/drugs, during a drug deal, while commiting a crime, or while hanging with friends), firearm discharge in high-risk situations (i.e. firearm discharge under the influence of alcohol/drugs, during a drug deal, while committing a crime, during a fight, while fleeing police, to scare someone, or while hanging with friends), and/or partner/non-partner firearm aggression (i.e., threats or use of firearm against another person). Sociodemographics, substance use, mental health, prior violence involvement, peer delinquency, and community violence exposure were also assessed. Descriptive statistics, bivariate analyses, and multivariate logistic regression identified rates and correlates of RFBs.
Results: 1,312 youth/EAs completed the survey (mean age 22; 30% Male; 51% Black; 56% receiving public assistance), with 136 (10%) youth/EAs reporting RFBs during the past 3-months. Of those reporting RFBs, 51% endorsed firearm ownership, 74% reported firearm carriage in high-risk situations, 40% endorsed firearm discharge in high-risk situations, and 31% reported partner/non-partner firearm aggression. Of note, while only 9% of youth/EAs reported either carriage or discharge for self-defense in the prior 3-months, 79% also engaged in RFBs. Multivariate logistic regression identified significant correlates of RFBs, including older age (AOR=1.08), male sex (AOR=1.84), Black race/ethnicity (AOR=1.62), full-time employment (AOR=1.88), substance misuse (AOR=2.34), ED visit for violent injury (AOR=2.29), attitudes favoring retaliation with a firearm (AOR=1.46), friends who own or carry firearms (AOR=4.73), higher levels of neighborhood collective efficacy (AOR=1.05), and higher levels of perceived community violence exposure (AOR=1.04).
Conclusion: Youth/EAs seeking treatment within an urban trauma center report elevated rates of RFBs that potentially increase their risk for subsequent injury and/or death. Prevention efforts should focus on enhancing elements of hospital and community violence prevention programs that address risky firearm behaviors among high-risk populations.
Financial Support: NIH/NIDA K23DA039341; NIH/NCATS UL1TR000433.